Some of the world's biggest health challenges will feature prominently on the agenda of the UN General Assembly next week.
Despite calls from developing countries for targets and funds, discussions are unlikely to include any grand plan to address the biggest causes of global disability – non-communicable diseases (NCDs).
Cancer, heart disease, diabetes and chronic lung disease – the Big Four – will get their time in the summitry spotlight. The focus will be on calls to strengthen existing mechanisms for controlling tobacco, managing alcohol intake, improving diet, and increasing physical activity. As such, leaders may be missing an opportunity to manage established risks to the global economy and livelihoods.
What is at risk?
The burden is immense. NCDs killed 63 percent of people who died worldwide in 2008, and they are the cause of half the world’s disability. The economic and personal costs are significant given that one-third of people dying from NCDs in low- and middle-income countries are of working age.
Demographic shifts may account for most of the expected 15 percent increase in NCD deaths globally between 2010 and 2020, but it hides a multitude of sins. Preventable deaths are expected to rise significantly in poorer regions. In rich countries, although deaths from some NCDs are slowly falling, their burden will continue to be a major driver of costs in expensive health and social care systems.
Recognising the inadequacy of response
The focus of the UN summit will be on intermediary factors strongly influenced by habit and choice. However, there is an increasing recognition that these choices are systematically curtailed through economic, social, and environmental change. Amongst these are our physical, dietary and cultural responses to urbanisation and globalisation.
UN reviews have estimated that if well-established 'best-buys' in prevention and treatment are pursued, an estimated 80 per cent of all heart disease, stroke and type 2 diabetes could be prevented, along with more than 40 per cent of cancers. However, the history of NCDs is not littered with great success. Behavioural risk factors have proven difficult in practice to reduce. This presents both a risk and an opportunity for international actors.
At first glance, it appears the summit has been weakened by the production of a draft political declaration rather than an outcomes document. It contains little in terms of concrete goals. Contentious issues over the influence of business interests across the tobacco, food, alcohol and pharmaceutical industries have played out in the way countries have blocked or changed previously agreed texts.
What can the summit do?
Tobacco use is the single most important risk factor for NCDs. The World Health Organization’s Framework Convention on Tobacco Control is an important legal instrument to address the NCD problem. Failure to address its poor implementation by national governments and strong lobbying by the tobacco industry on issues such as trade, regulation and taxation, will make a mockery of the summit’s intentions.
At the very least, a plan to develop goals and improve metrics must become apparent by the end of the summit. This is not just a role for government. NGOs must also look back and consider the broader absence of civil society in engaging with such a broad range of health issues.
Addressing half of the world’s disease burden is an incredible ask. Calls for technological solutions or health education are not going to solve the major concerns around weak health systems or the broader effect of globalized policies. However, if the summit leads to a more concerted effort by international and domestic actors to consider interdependencies, and challenge long-established simple discourses over what is in the national interest, then this is to be welcomed.
The key issues that will determine success in the long-term are population growth and ageing. This is a shared concern for many global systemic risks that are increasingly part of international affairs. Just as important is research and audit of health impacts in various sectors such as environment, education, employment, transport, and trade. Next week’s summit should bring NCDs into a wider debate about policy priorities and what are acceptable trade-offs for societies.
Global Health: A Seminal Moment?
Sudeep Chand, The World Today, August 2011